[Homage to Jirovec. Criticism of the taxonomic position of Pneumocystis carinii].
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Biomedical subjects
Publications and source records attributed to M Mojon.
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A parasitological (direct test and culture) and serological (IIF and ELISA) survey was carried out in 94 soldiers infested by a cutaneous South American leishmaniasis during a training in the guyanese forest. 52 p.c of the parasitological tests were positive, direct test being much more sensitive than cultures. By this technique, Leishmania Viannia guyanensis was detected 8 times, and Leishmania Viannia braziliensis twice. I.I.F. was negative in all cases because the utilization of a non-homologous antigen in the promastigote form and of the condition of its preparation. ELISA test utilizing the same antigen in a soluble form was specific and its sensitivity was 52 p.c. This technique was positive in 52 p.c of the cases, corroborating some diagnosis for which parasitological test was negative. 66 p.c of the total cases were confirmed.
The etiologic factors of protein-energy malnutrition (P.E.M.) have been studied in 59 children with kwashiorkor (KWK) or marasmus-kwashiorkor (MKWK) and living in an african urban area. The decline of breast feeding leads to an earlier P.E.M., mainly MKWK. This decline is linked to urbanization, mother's activities, dislocation of traditional structures and use of artificial formulas. Essentially based on cereals, the diet is responsible of the post-weaning P.E.M. Poverty, ignorance and food taboos are related to a lack in weaning food varieties. A small number of infants with KWK had a rich protein diet putting back the cause of an hypoproteic diet on the KWK onset. Infections play a determinant role in the onset of KWK and of some MKWK, after 2 years of age. Diarrhoea, measles, bronchopulmonary and parasitic diseases are the most prevalent infections. Among socio-cultural factors, conjugal disorders are predominating with child-mother break-up and father's bonding failure. At the opposite of rural areas, the family size is reduced. The three first birth ranges are specially concerned with young inexperienced mothers.
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From 1964 to 1983, thirty-three children have developed Pneumocystis carinii pneumonia (18 boys and 15 girls). The affection appears before 1 year of age in 73% of the cases (mean +/- SD: 6,12 +/- 4,6 months). The predisposing factors for the disease include hypotrophy (7), immune deficiency (26: 79%) (12 congenital and 14 acquired). The thymodependant lymphocytic system is concerned in 15 cases (46%) with only 5 neoplasic origins. The onset of the disease is in the first year of immuno-suppresive treatment in 71% of the cases. It is acute in 27% of the cases. Polypnea is found in 94% of the cases, cyanosis 73%, fever 70%, respiratory distress 64%. Distal endobronchial brushing associated with distal bronchopulmonary lavage and surgical pulmonary biopsy seem the best methods of direct positive diagnosis. The specific serology is less useful. Among the 20 treated children, 7 were cured (35%). The global mortality rate is still high (79%). The new proposed therapeutic schema includes either pentamidine as a "starter" effect (4 mg/kg/d IM/ X 5 d) associated with pyrimetamine-sulfadoxine (1,25 mg PYR/25 mg SUL/kg/d every 8 days) or trimethoprim-sulfamethoxazole (20 mg TMP/100 mg SMZ/kg/d X 14 d; efficient plasmatic TMP: 5 to 10 micrograms/ml). Chemoprophylaxy must be followed by all "high risk" patients during the totality of the immunosuppressive period (PYR-SUL every 15 days associated with folinic acid).
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Albendazole was given to some men for the first time. 131 patients (43 children) received different dosages, without clinical intolerance. Biological parameters were normal. Each study was made in two parts: - determination of the good dosage, - administration in a double-blind study (except for Strongyloides Stercoralis). Albendazole has a good efficiency against Enterobius Vermicularis, Trichuris trichiura, Ascaris lumbricoides and Necator americanus. Strongyloides Stercoralis seems to be killed by this drug, but complementary studies will be necessary.
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